1. Mike Ridler Head of Hearings General Dental Council An overview of Fitness to Practise www.gdc-uk.org

2. THE FIVE BASIC STEPS FOR STAYING OUT OF TROUBLE Keep your registered address up to date Set up a Direct Debit for your ARF Always have professional indemnity Never ignore the GDC if we write to you (we don’t forget and we won’t go away !) Do your CPD and submit the returns

3. Referrals 2013: 2990 complaints (almost double the number for 2011) 2014 : 3099 2015 : predict 3,300 www.gdc-uk.org

4. FTP Overview New complaint Triage Assessment Investigating Committee Practice Committee Resumed Hearing

5. Triage - overview Test – “is the allegation capable of forming an allegation that the Registrants FTP impaired”? Complaints are ‘triaged’ and cases that cannot or should not be pursued are closed In 2014, 888 cases were closed at Triage The remaining complaints continue on to casework for investigation and assessment www.gdc-uk.org

6. Triage – case examples Examples of cases closed at Triage: Registrant’s profession is entirely incidental to the case i.e. no indication that patients are at risk or evidence of a risk of detriment to the profession e.g. a registrant in dispute with neighbour or registrant registered on internet dating site. www.gdc-uk.org

7. Triage – case examples Further examples of cases closed at Triage: Dispute re clinical judgment provided in clinical dental report e.g. in civil claims where a dentist’s interpretation of a patient’s treatment is contradicted by a second expert Customer service issues which do not impact on care Level or quality of service where there is no suggestion that a registrant is directly responsible e.g. complaints relating to waiting time www.gdc-uk.org

8. Triage – case examples Examples of cases closed at Triage: Complaints where the GDC has simply been copied in to correspondence and there is no suggestion that patients are at risk Anonymous complaints where there is no suggestion that patients are at risk Contractual or employment disputes where there is no suggestion that patients are at risk and there is an appropriate recourse available through the courts www.gdc-uk.org

9. Assessment Caseworkers are allocated & investigate cases until sufficient information for assessment Casework Managers test – “Does the information provided amount to an allegation that the registrant’s fitness to practice is impaired?” Managers close cases that cannot be pursued In 2014, 1298 cases were closed at assessment Cases with a prospect of success are referred to the Investigating Committee www.gdc-uk.org

11. Investigating Committee (IC) The IC test: Is there a reasonable prospect of the allegations being found proven? If yes, is there a real prospect of a Practice Comm finding the registrant’s FTP impaired? Investigating Committee can:  Close a case with no further action  Give advice or issue a warning (published or unpublished)  Adjourn a case for further information  Or if the case is sufficiently serious, they will refer it on to a practice committee. www.gdc-uk.org

12. Investigating Committee (IC) If there is a serious risk to patients, the public or the registrant themselves, the IC can refer the case to the Interim Orders Committee (IOC) at the same time as referring it to Professional Conduct (PCC), Health (HC) or Professional Performance Committees (PPC) In 2014, the IC decided 1012 cases and referred 321 registrants to the PCC In 2014, the IC and Registrar together referred 264 cases for Interim Orders www.gdc-uk.org

13. Interim Orders Committee (IOC) The IOC does not make findings of fact – it can only make an assessment of risk An IO can only be imposed for a maximum of 18 months and must be reviewed every 6 months The High Court can extend orders on application The IOC can only impose a suspension or conditions Grounds for making an IO - public protection, in the public interest and in the registrant’s own interests The Registrar can also make referrals to the IOC In 2014, out of 264 referrals, 144 IOs were made and 104 were not made. 25 were adjourned for various reasons www.gdc-uk.org

14. Practice Committees [1] 3 committees – Health Committee (HC), Professional Performance Committee (PPC) and Professional Conduct Committee (PCC) 129 cases heard by PCC in 2013 187 cases heard by PCC in 2014 www.gdc-uk.org

15. After Referral by the IC (KPI: 9 months to the hearing) Legal activities Prosecution investigate Hearings - Case Management actions, set date and length Service and notification Defence prepare case Hearings activities Assemble panels Arrange venue Book LA, Steno etc. Cttee Sec, Usher Programme of business and other documents

16. Composition: usually 3, max 5 (Dentists, DCPs, Lay) Legal Adviser Supported by Hearings Team (Cttee Sec and Usher) Separation of functions inside the GDC:  Fitness To Practise Team: complaints handling, IC, prosecution (want to win their case)  Hearings Team: listings, Panels, arrange and support sessions (neutral, want case to be heard fairly and efficiently with no grounds for appeal) Professional Conduct Committee

17. What does the Practice Committee do? Makes decisions on cases in a 2 stage process: Listens to evidence, decides on facts, announces its findings on each allegation Listens to explanations, mitigation, submissions; decides on impairment and sanction

18. Powers of Practice Committees Decides if Fitness to Practise impaired If FTP impaired, imposes sanction Reprimand Conditions Suspension for up to 12 months Erasure (not less than 5 years) Sanctions must be considered in ascending order of seriousness

19. Practice Committees

20. Resumed Cases Suspended or conditional registration that requires review from any Practice Committee Sanctions are slightly different – panel cannot erase on review. Instead they can vary, revoke or extend the existing order or substitute the order. They can also suspend indefinitely after a period of 2 years continual suspension A dedicated Case Review Team are responsible for monitoring registrants’ compliance with these orders In 2013, 52 resumed cases heard resulting in the continuation of 21 suspension orders and 31 condition orders www.gdc-uk.org

21. Other reasons for case closure… Voluntary Removal (VR) - a registrant can apply for VR at any part of the FTP process Rule 10 application – the IC can be asked to review a decision of a previous IC if appropriate, to reassess what allegation(s) ought to be considered by a Practice Committee – this can lead to cases being closed post reassessment www.gdc-uk.org

22. Issues* in Conduct Cases 2014 (1) Poor treatment94 Fraud/dishonesty47 Poor practice management15 Failure to obtain consent/explain treatment37 No professional indemnity/insurance 5 Conviction/caution (alcohol, drugs, theft, fraud, assault…)27 Conviction (possessing indecent or pornographic images) 2 Personal behaviour15 Indecent assault, inappropriate sexual behaviour 6 Other (miscellaneous) 8 * Cases often involve multiple issues: these figures cover the main ones but not every element which has been raised in Charges.

23. Issues* in Conduct Cases 2014 (2) Failure to take appropriate radiographs 41 Missing oral cancers 2 Failure to inform patient of adverse incident 4 Prescribing issues 21 Basis of treatment not clear (NHS/private) 5 Hygiene, Cross-infection control, Hazardous waste 10 No medical/dental history taken 14 Failure to co-operate with GDC or disclose convictions 16 Misleading advertising 6 Working outside scope of practice 12 Making racially offensive comments 2 * Cases often involve multiple issues: these figures cover the main ones but not every element which has been raised in Charges.

24. www.gdc-uk.org View from the other regulators Some seeing significant rises in referrals  Optical Council + 48%  Pharmaceutical Council + 54%  Chiropractors – 25%  Nursing Council + 10%  GMC / GDC – 0%

25. www.gdc-uk.org What does our caseload contain?

26. www.gdc-uk.org Treatment issues

27. www.gdc-uk.org Patients Interests

28. What would it be like for you ? Long drawn out (15 months +) Uncertain Worrying, pre-occupying Very stressful – for you, family, others Best avoided if at all possible

29. Importance of Communications Skills Probably 50% of cases involve communications issues of some sort Get those right and your risk of appearing at the GDC falls sharply Treatment plans: copies to patient, amend if plans change Explain options, details of treatment, benefits and risks Explain the basis of treatment (NHS or private), and costs Surgery and sedation: written pre- and post-operative instructions Obtain proper consent, document it, get signatures Keep good notes – could the next treating dentist understand them ? Handle complaints well and they most probably will not go further Keep in touch professionally: LDC, BDA, FGDP etc; do your CPD

30. The not too distant future….. Case Examiners to be introduced in 2016 Role of case examiners Effective from late summer 2016 Investigating Committee not abolished but scaled back Begin advertisement for case examiners posts – before end 2015 Interviews in early Spring 2016 Recruits train and work up from early Summer 2016 www.gdc-uk.org

31. Fitness to Practise Improvements – 2015 Initiatives Dedicated Screening Team – focus solely on triage (2 day KPI) and faster Interim Orders referrals (28 day KPI) Lean review of FTP process with added focus on quality/timeliness Customer Satisfaction – online feedback for Registrants/ Informants/ Witnesses Introduction of case examiners with powers to agree undertakings www.gdc-uk.org

32. Other New Initiatives New Research Regulation of Dental Services Programme Board Online Patient Panel www.gdc-uk.org

33. New Research Complaints Analysis Statistical analysis of GDC complaints data; Nature and trends of Fitness to Practise complaints to the GDC; Limitations of data; Potential similar analysis of data from external organisations and whether valid and meaningful comparisons or trends could be identified; Further research the GDC can take to continue to build our knowledge base in the coming years. www.gdc-uk.org

34. Regulation of Dental Services Board Members: GDC, the CQC and NHSE (and now includes the NHS Business Services Authority) Aims: Better understanding of how the overall system of dental regulation in England works and what can be done to improve it. Identify areas of overlap between the GDC, CQC and NHSE and whether the right part of the system deals with issues about performance in the most cost effective way. Understand how risk is identified, how information is shared and how well co-ordinated the system is in the event of a significant incident. www.gdc-uk.org

35. Online Patient Panel Results 93% very or fairly satisfied, while 6% were very or fairly dissatisfied; 31% of panel members said that they have some concerns about quality of dental care; 24% indicated that they have some concerns about the behaviour of dentists and DCPs - the main concerns for panel members were about poor quality of work, competence, costs and /or transparency of pricing. www.gdc-uk.org

36. Future Engagement Stakeholder meetings to take place six times a year; Corporate Strategy Feedback; New monthly email for dental professionals, plus quarterly Gazette. www.gdc-uk.org

37. Case examples…… www.gdc-uk.org

38. Case example 1 - Smith S referred by Nottinghamshire Police for 2 x minor motoring offences – Careless driving and speeding Evidence suggests offences did not involve drugs, alcohol or other aggravating factors Offence 1 dealt with by way of Magistrates Court fine (£400) and offence 2 by way of a fixed penalty www.gdc-uk.org

39. Case example 1 - Smith Pass triage test? Refer for Interim order – if yes, when? Pass Assessment stage? Investigation Committee refer? If yes, which committee? Final hearing – likely sanction? www.gdc-uk.org

40. Case example 1 - Smith Closed at Triage Reassured no alcohol or drugs involved Registrant’s profession is entirely incidental to the case i.e. no indication that patients are at risk or evidence of a risk of detriment to the profession Not capable of forming an allegation of impaired FTP. www.gdc-uk.org

41. Case example 2 - Phillips Clinical treatment provided to elderly patient in 2012 Patient claims P failed to assess, record or address pain in his UL7 tooth – “severe pain on hot or cold” No x-rays taken and no follow up advice given P advised patient to use sensodyne toothpaste and applied “Duraphat” varnish to UL7 Pain continued for further 7-10 days Second dentist at practice identifies cavity after x-ray and fills tooth No FTP history and attended a training course following initial complaint www.gdc-uk.org

42. Case example 2 - Phillips Pass triage test? Refer for Interim order – if yes, at what stage? Pass Assessment stage? Investigation Committee refer? If yes, which committee? Final hearing – likely sanction? www.gdc-uk.org

43. Case example 2 - Phillips The Investigating Committee decided: “the Committee considers that in order to sufficiently diagnose the cause of the patient’s presenting symptoms, the Registrant should have carried out further investigations, such as taking radiographs. Consequently, the Committee is satisfied that there is a real prospect of allegations 1(a), 1(d) and 2(a) being found proven” Next step? “In the circumstances (no FTP history/remedial CPD), the Committee is satisfied that there is no real prospect of a practice committee finding that the Registrant’s fitness to practise is currently impaired and that it would therefore be inappropriate to refer this matter to a practice committee” www.gdc-uk.org

44. Case example 2 - Phillips The Investigating Committee decided to conclude the case: “To close this matter without action would fail to indicate to the Registrant the seriousness of the alleged deficiencies, which cover fundamental areas of dentistry including assessments and record keeping. Having again taken into account the Registrant’s lack of previous fitness to practise history and the remediation demonstrated by the Registrant, the Committee is satisfied that it is both sufficient and proportionate to close this case with advice” Advice: “Necessary to undertake thorough assessments and investigations of a patient’s presenting dental condition; and To maintain full, consistent and sufficiently detailed records which should include full details of all assessments, investigation and treatment carried out.” www.gdc-uk.org

45. Case example 3 - Bachada Defrauded NHS in excess of £80,000 Defrauded patients in sum of £3,000-4,000 – patients thought receiving NHS treatment but charged private rates Over 4 year period Attempted to conceal by re-writing/destroying patient records Pleaded guilty to 2 counts of conspiracy to defraud in 2010 20 months imprisonment Previous – 2004 suspended by GDC false claims against NHS/ providing unnecessary treatment www.gdc-uk.org

46. Case example 3 - Bachada Pass triage test? Refer for Interim order – if yes, when? Pass Assessment stage? Investigation Committee refer? If yes, which committee? Final hearing – likely sanction? www.gdc-uk.org

47. Case example 3 - Bachada FtP impaired by virtue of conviction Erasure “exists because certain behaviours are so damaging to a registrant’s fitness to practise and to public confidence in dental professionals that removal of their professional status is the appropriate outcome” Dishonesty – “Patients have a right to rely on registrants’ integrity. Important choices about treatment options and significant financial decisions can be made on the basis not only of registrants’ skill but also of their honesty. Dishonesty, particularly when associated with professional practice, is highly damaging to a registrant’s fitness to practise and to public confidence in dental professionals.” Ignored 2009 PCC warning Erased – no appeal. www.gdc-uk.org

48. Questions www.gdc-uk.org